{
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"IsOrgSubpart": "N",
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"OrgName": "BOYNTON BEACH PAIN & REHABILITATION INC",
"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "1814 NE MIAMI GARDENS DR",
"SecondLineMailingAddress": "#406",
"MailingAddressCityName": "NORTH MIAMI BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33179-5043",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "305-466-5665",
"MailingAddressFaxNumber": "305-466-8580",
"FirstLinePracticeLocationAddress": "3459 W WOOLBRIGHT RD",
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"PracticeLocationAddressCityName": "BOYNTON BEACH",
"PracticeLocationAddressStateName": "FL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "561-732-0033",
"PracticeLocationAddressFaxNumber": "561-737-4285",
"EnumerationDate": "05/25/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FEDER",
"AuthorizedOfficialFirstName": "DANNY",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "305-466-5665",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "CH8820",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}